Heroin: The Treatment of Addiction in Twentieth-Century Britain

Extract

What counts as authoritative expertise in the treatment of opiate addiction? The expansion and contraction of the drug policy community occurs atop a fulcrum upon which sways the see-saw of maintenance versus abstinence. Alex Mold's contribution to the history of drug policy and treatment further debunks the so-called ‘British system’ in a book that is deftly written, if clumsily titled. Acknowledging the symbolic value of the British system, long an important alternative to abstinence in global drug policy, Mold finds that an intense conflation of treatment and control has characterised the British regime. Although a contribution to the long neglected history of treatment and clinical practice, the book is a policy history that sets forth the structure within which drug treatment has become woefully inadequate to the demand. One of the book's strengths is its presentation of the two cases brought by the General Medical Council against Dr Ann Dally (1983 and 1986–7), the figure whose effective advocacy for a humanising influence lies at the heart of the book. Addicts who avoided the NHS and the publicly funded Drug Dependence Units (DDUs) sought treatment in private practice, placing so-called independent physicians such as Dally in the position of having to become addiction experts. This is a tale of contending forms of expertise, between general medicine and specialised medicine, between those who define addiction as a psychiatric condition and those who define ‘drug dependence’ as physiological, between admonitions to abstinence and evidence-based policy directed towards crime reduction.